By Ms Lizaan Schwartz, Provisional Psychologist at Minds & Hearts
As a professional working with adolescents on the autism spectrum at the clinic, I have observed an increased number of Self-Injurious behaviours being reported by clients’ parents and teachers. Self-Injurious behaviour is when a person physically harms themselves for different reasons. Self-Injurious behaviours in children on the autism spectrum can range from head banging on the floor, walls or other surfaces, hair pulling, arm biting, skin picking, or scratching etc.
Current literature suggests that Self-Injurious behaviours are highly prevalent among individuals on the autism spectrum, between 33% and 50% of the autism spectrum population. In their longitudinal study of 152 adolescents on the autism spectrum, Rattaz, Michelon and Baghdadli (2015) found that adolescents on the autism spectrum engage in Self-Injurious behaviours more than individuals diagnosed with an intellectual impairment.
Rattaz et al. (2015) observed that 35% of the adolescents that participated in their study engaged in Self-Injurious behaviours. When compared to previous studies by Richards et al. (2012), they noted that this rate was on the lower part of the range between 33% and 50%. Moreover, Self-Injurious behaviour rates remained stable between the ages of 8 to 15 years. At the age of 15 years, one third of the adolescents on the autism spectrum still presented with Self-Injurious behaviours. Taken together, research highlights that interventions need to be implemented at a young age when Self-Injurious behaviours are suspected to develop, so as to prevent children from engaging in these behaviours during adolescent years.
Rattaz et al., (2015) suggested that there was no relationship between the lethargy (low energy levels) domain and Self-Injurious behaviours domain for adolescents on the autism spectrum. In their study, however, they found the following difficulties were linked to Self-Injurious behaviours in adolescents on the autism spectrum:
• Severity of autism symptoms (Level of ASD diagnosis);
• Adaptive functioning difficulties, which were associated with adolescents’ engagement in daily living skills, socialisation and communication with others;
• Intellectual abilities; and
• Language level.
In relation to the above-mentioned findings, clinically I have noted the following factors as potential causes for a child to engage in Self-Injurious behaviours:
• They do not feel listened to;
• They are being bullied at school or by another sibling;
• When they lose a friendship they valued;
• When changes occur at home or school and they do not feel prepared for the change;
• When they are involved in arguments with other people or they hear family members argue;
• When they are being misunderstood by their peers; and
• When they struggle to engage in daily living skills.
When parents, teachers, support workers, or other health professionals notice that an adolescent on the autism spectrum is engaging in Self-Injurious behaviours, they may be guided by the following recommendations:
• Early intervention is key for Self-Injurious behaviours in adolescents on the autism spectrum
• If it is an emergency, please call 000 or present to the emergency department at your local hospital.
• Contact Lifeline 13 11 14 and speak to a counsellor 24-hour service.
• Respond Quickly – even when you think the child is trying to get attention, it’s never appropriate to ignore severe Self-Injurious behaviours. Immediately intervene to prevent severe Self-Injurious behaviours.
• Keep your responses “low key” by limiting your verbal responses, facial expression, and expression of emotions. Try to speak in a calm and clear voice to ground the child to calm down.
• Reduce demands – if, for example, the child is struggling to keep up with the pace at school or at home. Provide the child with the options to come back to the task at a later time.
• Redirect their attention to another activity that can’t be done at the same time as the Self-Injurious behaviour.
• Provide positive affirmations if they were able to redirect their attention successfully.
• Place barriers between the child and the object that is causing harm or are used to harm themselves.
• Think of the function of the behaviour – keep record of when the child is engaging in these behaviours, when did the Self-Injurious behaviours start, how many days do they engage in this behaviour, environmental factors, any change in the environment, and how you think the child is feeling.
• Increase routine and structure in home and school environment to decrease levels of anxiety.
• Provide sensory alternatives like a weighted blanket, jumping on the trampoline, swinging on the swing etc.
• Medication is sometimes used when the Self-Injurious behaviours is very severe and longitudinal. Ensure that the prescribed medication is monitored by his/her GP, Paediatrician or Psychiatrist.
I recommend the following Apps to assist with Self-Injurious behaviours for adolescents on the autism spectrum:
• Calm Harm (Visit website: https://calmharm.co.uk) Available on iTunes, Google Play or Android
• Self-Heal (Visit Website: http://self-healapp.co.uk) Available on iTunes, Google Play or Android
The rate of Self-Injurious behaviours is increasing within the adolescent population with autism. It is therefore key that we are informed about the presentation of these behaviours and available interventions. The purpose of this article is to inform others of the research available on Self-Injurious behaviours and intervention strategies. To read more about understanding Self-Injurious behaviours in adolescents on the autism spectrum I recommend reading Understanding and Treating Self-Injurious behaviour in Autism. I have included the link in the references.
Rattaz, C., Michelon, C., & Baghdadli, A. (2015). Symptom severity as a risk factor for self-injurious behaviours in adolescents with autism spectrum disorders. Journal of Intellectual Disability Research, 59(8), pp. 730-740.
Richards, C., Oliver, C., Nelson, L., & Moss, J. (2012). Self-injurious behaviours in individuals with autism spectrum disorder and intellectual disability. Journal of Intellectual Disability Research, 46, pp.476-489.
Edelson, S.M. (2016). Understanding and Treating Self-injurious behaviour in Autism. Autism Research Institute. Retrieved from: https://www.autism.com/sib_book